Erythema Multiforme

Excerpt

Erythema multiforme is an immune-mediated hypersensitivity reaction with cutaneous and mucosal involvement. Clinically, erythema multiforme is characterized by macular, papular, bullous, or urticated lesions with a distinctive pattern of "target lesions" distributed primarily across extremities. Mucosal surfaces, including ocular, oral, and genital mucosa, may also be involved. Significant mucosal involvement differentiates erythema multiforme major from multiforme minor. Erythema multiforme is a self-limiting condition, usually resolving without significant complications, and is now classed as separate from Stevens-Johnson syndrome and toxic epidermal necrolysis. Only a limited number of cases become persistent. Erythema multiforme's etiologies are variable and numerous, and its clinical course is generally favorable.

Most lesions appear in 48 to 72 hours, most frequently in the extremities. Generally, the lesions remain localized to 1 site and heal within 7 to 21 days. Common precipitating factors include infections such as herpes simplex virus, histoplasmosis, and Epstein Barr virus. Recurrences are not uncommon if the trigger is herpes simplex. While most erythema multiforme cases are mild, severe cases can be life-threatening. The mucous membranes are involved in 2% to 10% of individuals. Overall, the majority of cases of erythema multiforme are linked to medications. Management of acute erythema multiforme focuses on improving symptoms, managing pain, and supporting recovery, which usually happens within 2 weeks. Interventions for recurrent erythema multiforme aim to reduce or eliminate repeated disease episodes.